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Villa Park officials weigh billing ambulance calls at full GEMT rate amid audit concerns
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Summary
Village staff presented a plan to bill ambulance transports at 100% of the Ground Emergency Medical Transport (GEMT) cost-report rate to reduce audit risk and increase projected revenue; trustees pressed staff on effects for residents’ out-of-pocket costs and write-offs.
Deputy Chief Reposch, the village’s deputy chief of administration, told the Village Board of Trustees on Feb. 9 that Villa Park is considering billing ambulance transports at 100% of the Ground Emergency Medical Transport (GEMT) cost-report rate rather than the current ordinance structure that sets resident and nonresident rates at 50% and 75% of that rate.
“So what is GEMT? It’s the Ground Emergency Medical Transport Program,” Reposch said during a high-level presentation explaining how the village’s annual cost report, payer mix and state administration of GEMT determine allowable rates. He said the program is administered by the Illinois Department of Health and Family Services (HFS) and provides supplemental reimbursements above Medicare base rates.
Presenters told trustees that Villa Park’s 2025 payer mix was heavily weighted toward Medicaid — roughly 62–63% — with about 20–21% commercial insurance and approximately 13% Medicare. Using 2025 transport counts as the base, staff showed a projection that billing at the village’s current adjusted 50%/75% structure would yield about $2.25 million in gross ambulance revenue, while billing at 100% of the GEMT cost-report rate would increase that projection to about $2.5 million.
Staff cautioned that those projections use historical transport counts and cannot predict 2026 volumes precisely. They also said the GEMT program requires providers to charge the full final rate for Medicaid transports and that the state expects roughly 50% of the GEMT payment be returned to the state as an administrative repayment; if repayments fall short, a provider could be liable for the difference and could risk exclusion from the program, presenters said.
Trustees focused questions on how higher ordinance rates might affect residents’ out-of-pocket bills. Staff explained that commercial policies typically route payments through a clearinghouse (Waystar) and that payments are released as patients meet deductibles; they said the village continues to seek co-pays, coinsurance and deductibles from insured patients and that private-pay charges are handled separately. Officials said the department wrote off about $308,000 last year, with roughly $170,000 of that forwarded to collections; the village also maintains procedures for hardship waivers and resident write-offs.
Director Samantha Rovic of Paramedic Billing Services was present for technical questions. She and Reposch advised the board that maintaining billing levels below the state’s cost-report-driven rate can trigger audits and create the risk of audit findings or disqualification from GEMT participation.
No formal vote on changing the ordinance or setting a new ambulance fee was taken at the meeting. The presentation concluded with trustees asking for follow-up reports (including detailed write-off and resident-impact data) before any ordinance change is scheduled for a hearing or vote.
The board did not set a date for final action during the Feb. 9 session; staff said more information and reports could be provided at a future meeting.
